Provider Demographics
NPI:1295820306
Name:LUNA, PHYLLIS B (LADAC)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:B
Last Name:LUNA
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 BINDEL ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-6505
Mailing Address - Country:US
Mailing Address - Phone:505-628-1498
Mailing Address - Fax:
Practice Address - Street 1:1902 BINDEL ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-6505
Practice Address - Country:US
Practice Address - Phone:505-628-1498
Practice Address - Fax:505-746-9840
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3786101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)